Drugs to Prevent and Treat the Flu

It’s that time of year again: flu season. With September right around the corner, you should be preparing to get your annual vaccine against influenza or, as it is usually called, the flu.

The flu is a highly contagious respiratory illness that is caused by a virus. Symptoms of the flu include cough, sore throat, runny or stuffy nose, body aches, headache, and fatigue, all of which can range from mild to severe. Often the flu is accompanied by fever, with its usual symptoms of alternating chills and uncomfortable warmth. While most flu symptoms involve the respiratory tract, vomiting and diarrhea can also occur; these symptoms are more common in children than adults.

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Most people recover from the flu within a few days to less than two weeks. However, some people develop serious and sometimes life-threatening complications from the flu. Such complications may include secondary infections such as pneumonia, bronchitis, and ear or sinus infections, or the worsening of a preexisting chronic condition such as asthma or congestive heart failure.

Diabetes and the flu

If you have diabetes, you are considered at high risk for getting the flu and for developing complications, even if your blood glucose is well controlled. This is because diabetes can impair your immune system’s ability to fight off an attacking virus such as the flu. Then, once you catch the flu, your body may respond negatively in several ways to the stress of being sick. During times of stress, the body releases stress hormones such as epinephrine (adrenaline) and cortisol, which raise your heart rate and blood pressure. Epinephrine – along with glucagon, a hormone produced by alpha cells in the pancreas – also causes the liver to release stored glucose, leading to elevated blood glucose levels in many people with diabetes.

Being ill can also make you feel less like eating and disrupt your regular meal plan, which can make blood glucose levels even more erratic. It is thus possible for the flu to lead to acute diabetes complications such as ketoacidosis – a life-threatening condition brought about by a lack of insulin, and marked by extremely high blood glucose and often a fruity odor in the breath – or to dangerous hypoglycemia (low blood glucose), depending on the balance of hormones and food intake during the illness.

Flu prevention

The best defense against the flu is prevention, which means getting vaccinated against the virus. The Centers for Disease Control and Prevention (CDC) recommends that people at high risk for the flu get a flu shot to help protect themselves and those around them (see “Who Should Get a Flu Shot?”). The vaccine should be taken once a year, ideally in September or October or as soon as it becomes available to the public. Once you get your flu shot, it will take about two weeks for your body to develop antibodies, which are proteins used by your immune system to identify and destroy the viruses that cause the flu. If you miss the vaccine in the early fall, keep in mind that flu season generally peaks in the winter months, so you can still benefit from getting a flu shot later in the year.

The vaccine for flu season 2012—2013 is made up of three inactive viruses, selected by experts around the world based on research into which types of flu viruses are likely to be the most common. This year’s viruses are an A/California/7/2009 (H1N1)-like virus; an A/Victoria/361/2011 (H3N2)-like virus; and a B/Wisconsin/1/2010-like virus. While you don’t need to remember the names of these viruses, it is important to note that the flu vaccine protects only against selected strains; it does not provide 100% protection against the flu, because other, less common flu viruses may still be spread during the season.

The most common flu viruses tend to vary from year to year, leading to a different flu shot from one year to the next. Even when the vaccine stays the same, however, that does not mean you should skip your flu shot if you got one the previous year: After being vaccinated, your immunity to the flu declines over time and may not be strong enough to prevent getting sick this season.

It used to be thought that people who are allergic to chicken eggs should not get the flu shot because chicken eggs are used in making the vaccine. That thinking is changing, however, because of studies in which not all people who are allergic to chicken eggs have a serious reaction to flu shots. Experts now say that egg-allergic people who choose to get a flu shot should get it from a health-care provider who is familiar with egg allergy and should remain in the provider’s office for observation for 30 minutes after the injection. If you have not previously gotten a flu shot because of a chicken egg allergy, speak to your health-care provider about the safety of getting one now. If you have had a serious reaction to eggs, your health-care provider may still advise against it. Egg-allergic people should not get the nasal-spray flu vaccine, which is made with live, weakened flu viruses.

The most common form of flu vaccine is an injection given into muscle tissue, just as most other vaccines are given. Another form is given as a microinjection, using an extremely short needle to deposit the vaccine under the skin. This form of vaccine, however, may not be widely available this year and may cost more money. The nasal-spray form of the vaccine is recommended only for healthy people ages 2—49 who are not pregnant and do not have certain health conditions, one of which is diabetes.

You may be able to get a flu shot in your health-care provider’s office. If not, ask your provider’s office staff where flu shots are available in your area. Pharmacies, health departments, and hospital outpatient clinics often offer the vaccine, either at their own facilities or in places such as schools, churches, businesses, and senior centers. Another helpful resource is the “Flu Vaccine Finder” developed by the CDC, located at www.flu.gov/widgets/vaccinelocator.html.

Flu shots should be given by a health-care professional in all cases, and you should be asked beforehand about any relevant allergies. It’s a good idea to let your health-care provider know if you get a flu shot somewhere else. If possible, bring a confirmation receipt of the vaccine to your provider’s office–or have one sent from the location where you received the vaccine–to help maintain an accurate record of your vaccinations.

Medicare and most insurance plans cover the flu vaccine. However, if you get your shot somewhere other than your regular health-care provider’s office, you may want to check to see if the location handles insurance billing for the flu vaccine.

Flu treatment

If you suspect that you have caught the flu, it is important to seek treatment immediately. As noted earlier, people with diabetes have a higher risk of potentially dangerous flu complications when they get sick. Along with evaluating your symptoms, your health-care provider may order laboratory tests – usually involving a nasal or throat swab – before deciding what treatment is best for you.

A couple of drugs are widely available to treat the flu (see “Common Drugs to Treat the Flu”). They are most effective if begun within two days of developing flu symptoms – another reason you should not wait before seeing your health-care provider if you believe you might have the flu. Antiviral drugs for the flu are available as pills, in liquid form, and as an inhalable powder. While these drugs will not provide an instant cure for flu symptoms, they can help shorten the time you are ill by one to two days and may help prevent complications such as pneumonia. It is important to note that these drugs are specifically designed to treat the flu; they will not treat any other virus or any bacterial infection, just as an antibiotic cannot treat the flu or any virus. A prescription from your health-care provider is required to obtain antiviral drugs for the flu.

Sometimes antiviral drugs are prescribed to people who have been exposed to the flu virus but have not yet developed any flu symptoms. This can help limit a flu breakout within a community or household. The best way to prevent the flu from spreading, however, is for everyone who is eligible for a flu vaccine to get one – and this applies especially to people with diabetes.

Staying healthy

When you have diabetes, there are so many health-related measurements and procedures to pay attention to that adding yet another item to your agenda – even one as small as getting a flu shot – may feel like one too many. But look at the big picture, and remember that avoiding the flu is in your best interest. When you consider that this virus can make you sick for weeks, upset your blood glucose control, and wreak havoc on your daily activities, it becomes clear that an ounce of prevention is far better than a pound of cure. If you haven’t already gotten your flu shot this year, make getting one now a priority. It’s not too late, and it can make a big difference in your ability to stay healthy and do the things that you enjoy this winter and spring.

Laura Hieronymus is a nurse specialist and certified diabetes educator from Lexington, Kentucky. She is a Medical Information Senior Specialist with Amylin Pharmaceuticals, Inc. Dr. Kelly Velasco is a pharmacist and a Medical Information Senior Specialist with Amylin Pharmaceuticals, Inc., in San Diego, California.

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